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Video Details
"XP Treatment Planning Challenge - Phase I" - Parameters for Integration of Aesthetics and Function in Implant Dentistry

Description:
An interdisciplinary approach has never been more essential to offer the patient the best possible treatment plan and outcomes. Moreover, the general dentist and specialist must not only know what each member of the team must and is capable of doing, but essential to guide and provide the patient with a successful execution and results. Several restorative options are available, but harmony between the compromised tooth/teeth, final restoration and occlusion is essential for a biologically sound result that will enable the tooth to function indefinitely. While compromised cases can be extremely challenging, the comprehensive wisdom can salvage a tooth or provide a healthier environment for the next phase of treatment. This Case report presentation will be in 2 Parts. Part 1 will feature the diagnostic cascade and ask you to consider different treatment approaches to the case. Please place your comments and treatment suggestions in the comment section. Part 2 next week will showcase the actual treatment performed.

Date Added:
10/22/2015

Author(s):

Sergio Rubinstein, DDS Sergio Rubinstein, DDS
Dr. Sergio Rubinstein received his dental degree from the Universidad Tecnologica de Mexico in 1980. He went on to complete a specialty program in Periodontal-Prosth...
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Online Videos / Surgery / Periodontic Surgery / "XP Treatment Planning Challenge - Phase I" - Parameters for Integration of Aesthetics and Function in Implant Dentistry




Questions & Comments
Vicente Rodriguez - (11/3/2015 9:14 AM)

Excellent presentation and very well organized, looking forward to see the second part of it, thanks

Sergio Rubinstein - (10/17/2015 11:45 AM)

As Doctors are responding to the presentation, there was no cephalometric study done, patient does not have sleep apnea, is in good general health and no medications are taken! No need to apologize for a long response, this is exactly what DentalXP is all about, we are all always learning from each other!

Alaa YASSIN - (10/17/2015 3:17 AM)

Thank you Sergio for this interesting well presented case, It a great idea to share ideas with colleagues regarding such complicated interdisciplinary cases! I’m happy to share my thoughts about this case, and hopefully we all will benefit from the discussion (Waiting for the part II soon) Actually, this case should be approached carefully with initial essential steps of: Diagnosis/Etiology, building the appropriate team, determine the treatment objectives…etc. Some very important diagnostic elements are missing in the presentation and we need to have them before we proceed: Cephalometric and Panoramic X ray, Full face analysis to determine the facial thirds, and the vertical dimensions of the maxillary-mandibular complex. I’d start with the Diagnosis and Etiology for the case which I found as: - Chronic periodontitis generalized moderate and localized sever - Anterior open bite with sever malocclusion - Primary occlusal trauma turned into a secondary one. - Mucogingival deformities and generalized gingival recession - Localized lacking of attached gingiva. - None carious cervical lesions. - Failing restorations. - Caries - Although not mentioned but the patient seems to have bruxism! - So, in my opinion the primary etiology for the case is the malocclusion! According to the diagnosis, I will summarize the headlines of treatment objectives into: - Stabilizing and controlling the periodontal disease. - Correct the malocclusion (Ortho/Surgery). - Reconstruction of hard and soft oral tissues (Grafting) - Restore the dentition and the missing teeth. Preparing for the treatment steps, I’d start with oral hygiene instructions reinforcement, medical consultation from the patient’s primary care MD regarding any possible systematic diseases (Diabetes…etc), Fabricating an initial occlusal guard to start with as an occlusal forces reliever and a space maintainer in the future after extracting the hopeless teeth. Taking good models with suitable mounting / X rays/ Photos to sit down with the team and discuss in details. Regarding the treatment team: I’d suggest to include Prosthodontist, Orthodontist, Oral surgeon, Periodontist, and endodontist. With possibly the prosthodontist as the team leader! The initial treatment plan should include orthodontic/surgical corrections with a suitable setup and wax up to determine the surgical method needed to correct the open bit (Pre maxilla orthognathic surgery in the meaning of Wassmund technique or more extensive bi max procedure?!) When everything is ready, The treatment sequence I’s suggest would be: - Extraction of hopeless teeth #s: 3, 4, 5, 12 with vertical and horizontal ridge reconstruction/augmentation using a long turnover grafting materials (Xenograft, Autogenous cortical blocks, Titanium reinforced none resorbable membranes/Titanium mesh…etc) - # 24 Endo treatment with internal whitening. - Full mouth scaling and root planing, and re-evaluation after 4- 6 weeks of good oral hygiene. - Replacing the failing restorations (Temporization for the failing crowns). - Make sure to stabilize the periodontal disease before proceeding and make sure to keep the patient under 2 month recall during the ortho treatment to prevent any break down. - Free gingival grafts surgeries at the sites that lacking attached gingiva (Speacially the premolars) prior the ortho treatment. - Ortho treatment in the goal of put the dentition I the right alignment. - Oral orthognathic surgery to correct the anterior open bite (Wassmund/Wandurrer technique of the pre maxilla) - Ortho stabilization period post surgery and final alignment. - Implant placement at #s: 3, 5 for a future 3 units bridge and # 12 for a future single crown. - Periodontal surgeries including: Root coverage procedures (CTG/Alloderm), Osseous surgery and GTR. - Restoring the crowns over the implants. - Final restorative phase including definitive restorations and optional cosmetic touches ( Veneers, Lumineers). - Final occlusal guard. - 4-6 month recall. Those are my thoughts regarding this case, My apologies for the long response, looking forward for the discussion! Thanks again to Sergio for this great case…and the big thanks is to DentalXP for gathering us as always :). Cheers, Alaa

Ronald Goldstein - (10/16/2015 5:38 PM)

Excellent thought processes considered in the diagnostic approach to this patient, Sergio...and I really look forward to Part II

Maurice Salama - (10/16/2015 8:17 AM)

Sergio; Great case for thought and discussion. Typically today, we immediately sacrifice the "questionable" dentition to facilitate implant replacement. Here, I would attempt everything possible to retain the dentition until we can gain an acceptable occlusal position. Occlusal adjustment, periodontal Therapy and possible GTR, Orthodontics.....then Re-Eval. I look forward to Part 2. regards Maurice

Duane Keuning - (10/15/2015 10:11 PM)

1- Full articulator mounting in CR for diagnostic wax-up closing VDO to achieve anterior esthetics 2- extract hopeless teeth (#3-5 and #12) and place block grafts and provisionals 3- 4Q S/RP (laser and/or Arestin prn) 4- Allow 3-6 months in provisionals to test new occlusion and monitor perio stability etc 5- Final restorations 6- 3 month perio recall

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